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Lalya I, Benchakroun N, Sifat H, El Kacemi H, B Amaoui, El Hfid M, Sahraoui S, El Mazghi SA, Tahri A, Benider A, Acharki A. [Stereotactic radiotherapy in Morocco : Inventory and technological compatibility with the minimum requirements of international recommendations of good practice]. Cancer Radiother 2023; 27:676-681. [PMID: 37482465 DOI: 10.1016/j.canrad.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023]
Affiliation(s)
- I Lalya
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Hôpital Militaire d'Instruction Mohammed-V, Rabat, Maroc; Université Mohammed-V, Rabat, Maroc.
| | - N Benchakroun
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Centre d'oncologie Mohammed VI- CHU de Casablanca, Casablanca, Maroc; Université Hassan II, Casablanca, Maroc
| | - H Sifat
- Hôpital Militaire d'Instruction Mohammed-V, Rabat, Maroc; Université Mohammed-V, Rabat, Maroc
| | - H El Kacemi
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Université Mohammed-V, Rabat, Maroc; Institut National d'Oncologie (INO), Rabat, Maroc
| | - B Amaoui
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Centre universitaire d'oncologie, Agadir, Maroc
| | - M El Hfid
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Centre universitaire d'oncologie, Tanger, Maroc
| | - S Sahraoui
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Centre d'oncologie Mohammed VI- CHU de Casablanca, Casablanca, Maroc; Université Hassan II, Casablanca, Maroc
| | - S A El Mazghi
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Centre international d'oncologie, Fès, Maroc
| | - A Tahri
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Clinique spécialisée d'oncologie Menara, Marrakech, Maroc
| | - A Benider
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Clinique d'oncologie Ryad, Casablanca, Maroc
| | - A Acharki
- Association d'Oncologie Radiothérapie du Maroc (AORAM), Casablanca, Maroc; Clinique d'oncologie Ryad, Casablanca, Maroc
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Stepanek CJ, Haynes JA, Fletcher S. Evaluation of a complementary metal oxide semiconductor detector as a tool for stereotactic body radiotherapy plan quality assurance. Phys Imaging Radiat Oncol 2023; 25:100418. [PMID: 36755894 PMCID: PMC9900433 DOI: 10.1016/j.phro.2023.100418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Background and purpose A sub-mm resolution Complementary Metal Oxide Semiconductor sensor has been developed for stereotactic radiotherapy quality assurance. Herein we evaluate its basic dosimetric performance and its application for linac C-arm stereotactic body radiotherapy (SBRT) plan quality assurance. Materials and methods The detector was integrated into its accompanying phantom or in Water Equivalent Plastic (WEP). The measurement reproducibility, stability, dose linearity and dependence on angularity, dose rate and field size were investigated. Clinical plan measurements were compared to our radiotherapy treatment planning system and radiochromic film. Sensitivity to introduced Multi Leaf Collimator (MLC) offsets was evaluated by simulating single MLC offsets in SBRT plans and comparing measurements to expected doses. Results Signal reproducibility was within ± 0.1 % and output calibration was stable over a 6 month period. Detector showed good linearity with dose (r2 = 1). Signal decreased by 5 % when dose rate was decreased from 1300 MU/min to 300 MU/min. Output factors agreed within 0.5 % of chamber measurements for 1x1 cm field sizes or greater. Angularity measurements showed good agreement with reference. For measurement of planned clinical doses, gamma pass-rates were 98.5 % ± 2.3 % (treatment planning system reference, 2 %/2mm) and 99.2 % ± 1.0 % (film reference, 2 %,2mm). The detector also showed sensitivity to errors of 1 mm offsets in MLC positioning. Conclusion The detector performed well when used for pre-treatment SBRT plan quality assurance, offering a good alternative to radiochromic film.
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Paoletti L, Ceccarelli C, Menichelli C, Aristei C, Borghesi S, Tucci E, Bastiani P, Cozzi S. Special stereotactic radiotherapy techniques: procedures and equipment for treatment simulation and dose delivery. Rep Pract Oncol Radiother 2022; 27:1-9. [PMID: 35402024 PMCID: PMC8989452 DOI: 10.5603/rpor.a2021.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/14/2021] [Indexed: 12/25/2022] Open
Abstract
Stereotactic radiotherapy (SRT ) is a multi-step procedure with each step requiring extreme accuracy. Physician-dependent accuracy includes appropriate disease staging, multi-disciplinary discussion with shared decision-making, choice of morphological and functional imaging methods to identify and delineate the tumor target and organs at risk, an image-guided patient set-up, active or passive management of intra-fraction movement, clinical and instrumental follow-up. Medical physicist-dependent accuracy includes use of advanced software for treatment planning and more advanced Quality Assurance procedures than required for conventional radiotherapy. Consequently, all the professionals require appropriate training in skills for high-quality SRT. Thanks to the technological advances, SRT has moved from a “frame-based” technique, i.e. the use of stereotactic coordinates which are identified by means of rigid localization frames, to the modern “frame-less” SRT which localizes the target volume directly, or by means of anatomical surrogates or fiducial markers that have previously been placed within or near the target. This review describes all the SRT steps in depth, from target simulation and delineation procedures to treatment delivery and image-guided radiation therapy. Target movement assessment and management are also described.
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Affiliation(s)
- Lisa Paoletti
- Radiotherapy Unit, AUSL Toscana Centro, Florence, Italy
| | | | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Enrico Tucci
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
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Falcinelli L, Menichelli C, Casamassima F, Aristei C, Borghesi S, Ingrosso G, Draghini L, Tagliagambe A, Badellino S, di Monale E Bastia MB. Stereotactic radiotherapy for lung oligometastases. Rep Pract Oncol Radiother 2022; 27:23-31. [PMID: 35402023 PMCID: PMC8989443 DOI: 10.5603/rpor.a2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
30–60% of cancer patients develop lung metastases, mostly from primary tumors in the colon-rectum, lung, head and neck area, breast and kidney. Nowadays, stereotactic radiotherapy (SRT ) is considered the ideal modality for treating pulmonary metastases. When lung metastases are suspected, complete disease staging includes a total body computed tomography (CT ) and/or positron emission tomography-computed tomography (PET -CT ) scan. PET -CT has higher specificity and sensitivity than a CT scan when investigating mediastinal lymph nodes, diagnosing a solitary lung lesion and detecting distant metastases. For treatment planning, a multi-detector planning CT scan of the entire chest is usually performed, with or without intravenous contrast media or esophageal lumen opacification, especially when central lesions have to be irradiated. Respiratory management is recommended in lung SRT, taking the breath cycle into account in planning and delivery. For contouring, co-registration and/or matching planning CT and diagnostic images (as provided by contrast enhanced CT or PET-CT ) are useful, particularly for central tumors. Doses and fractionation schedules are heterogeneous, ranging from 33 to 60 Gy in 3–6 fractions. Independently of fractionation schedule, a BED10 > 100 Gy is recommended for high local control rates. Single fraction SRT (ranges 15–30 Gy) is occasionally administered, particularly for small lesions. SRT provides tumor control rates of up to 91% at 3 years, with limited toxicities. The present overview focuses on technical and clinical aspects related to treatment planning, dose constraints, outcome and toxicity of SRT for lung metastases.
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Affiliation(s)
- Lorenzo Falcinelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | | | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | | | | | - Serena Badellino
- Radiation Oncology Department, A.O.U. Città della Salute e della Scienza, Turin, Italy
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Barzilai O, Laufer I, Robin A, Xu R, Yamada Y, Bilsky MH. Hybrid Therapy for Metastatic Epidural Spinal Cord Compression: Technique for Separation Surgery and Spine Radiosurgery. Oper Neurosurg (Hagerstown) 2019; 16:310-318. [PMID: 29889256 PMCID: PMC7189205 DOI: 10.1093/ons/opy137] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 06/04/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite major advances in radiation and systemic treatments, surgery remains a critical step in the multidisciplinary treatment of metastatic spinal cord tumors. OBJECTIVE To describe the indications, rationale, and technique of "hybrid therapy" (separation surgery and concomitant spine stereotactic radiosurgery [SRS]) along with practical nuances. METHODS Separation surgery describes a posterolateral approach for circumferential epidural decompression and stabilization. The goal is to decompress the spinal cord, stabilize the spine, and create adequate separation between the neural elements and the tumor for SRS to achieve durable tumor control. RESULTS A transpedicular route to achieve ventrolateral access and limited resection of the tumorous vertebral body is carried out. In the setting of high-grade cord compression, caution must be taken when performing the tumor decompression. "Separation" of the ventral epidural tumor component anteriorly creates space for concomitant SRS while a simple laminectomy would not adequately achieve this goal. Dissection of the posterior longitudinal ligament allows maximal ventral decompression. Gross total tumor resection is not crucial for durable tumor control using the "hybrid therapy" model. Thus, attempts at ventral tumor resection may unnecessarily increase operative morbidity. Cement augmentation of the construct or vertebral body may improve construct stability. CT myelogram is the preferred exam for postoperative SRS planning. Radiosurgical planning constitutes a multidisciplinary effort and guidelines for contouring in the postoperative setting have recently become available. CONCLUSION Separation surgery is an effective, well-tolerated, and reproducible surgery. It provides safe margins for concomitant SRS. Combined, this "Hybrid Therapy" allows durable local control, maintenance of spinal stability, and palliation of symptoms, while minimizing operative morbidity.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Adam Robin
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ran Xu
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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Treatment-Related Adverse Effects in Lung Cancer Patients after Stereotactic Ablative Radiation Therapy. JOURNAL OF ONCOLOGY 2018; 2018:6483626. [PMID: 30402100 PMCID: PMC6193322 DOI: 10.1155/2018/6483626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 12/25/2022]
Abstract
Introduction Lung cancer is a disease which, despite the advancements in treatment, still has a very poor 5-year survival rate. Stereotactic ablative radiation therapy (SABR) is a highly advanced, sophisticated, and safe treatment which allows patients with early stage lung cancer to be treated effectively without invasive procedures and with excellent clinical outcomes. Avoiding surgery minimises morbidity and recovery time, bettering patients' quality of life. Furthermore, SABR allows patients unsuitable for surgery to still undergo curative treatment. Methods We aimed to review SABR-related normal tissue toxicities reported in the literature. While many studies assess safety, clinical efficacy, and disease control of SABR for lung cancer, the number of comprehensive reviews that analyse SABR-related side-effects is scarce. This integrative review summarises the toxicities reported in literature based on published clinical trials and tumour location (central or peripheral tumours) for available SABR techniques. Given that the majority of the clinical studies did not report on the statistical significance (e.g., p-values and confidence intervals) of the toxicities experienced by patients, statistical analyses cannot be performed. As a result, adverse events are compiled from clinical reports; however, due to various techniques and nonstandard toxicity reports, no meta-analysis is possible at the current stage of reported data. Results When comparing lobectomy and SABR in phase III trials, surgery resulted in increased procedure-related morbidity. In phase II trials, very few studies showed high grade toxicities/fatalities as a result of SABR for lung cancer. Gross target volume size was a significant predictor of toxicity. An ipsilateral mean lung dose larger than 9 Gy was significantly associated with radiation pneumonitis. Conclusions Based on the studies reviewed SABR is a safe treatment technique for lung cancer; however, further well-designed phase III randomised clinical trials are required to produce timely conclusive results and to enable their comparison and statistical analysis.
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Do SABR-related toxicities for lung cancer depend on treatment delivery? Crit Rev Oncol Hematol 2018; 129:67-78. [PMID: 30097239 DOI: 10.1016/j.critrevonc.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/10/2018] [Accepted: 06/18/2018] [Indexed: 11/20/2022] Open
Abstract
Stereotactic ablative radiation therapy for lung cancer is an advanced technique where tumours are ablated with hypofractionated radiation doses, with a high degree of accuracy. The aim of this paper is to review the available literature and to discuss the SABR-induced toxicities for lung malignancies as a function of radiation delivery technique. A Medline search was conducted to identify the appropriate literature to fulfil the aim of this review and data from all applicable papers were collated and analysed. The most common techniques of SABR delivery employ linear accelerators, CyberKnife robotic radiosurgery system, TomoTherapy and the Novalis beam surgery system. Linear accelerator-based treatments give rise to a variety of toxicities that are strongly dependent on both patient-related factors and planning/dosimetry-related factors. The limited number of studies using CyberKnife reported low grade toxicities. Grade three toxicities mainly include fatigue and chest pain, usually in less than 10% of patients. All treatment techniques presented show efficiency in SABR delivery with various toxicities which, at this stage, cannot render one technique better than the other. For more conclusive results, well-designed phase three randomised clinical trials are required with better patient selection criteria, including dose and fractionation, treatment machine and technique, along with the consistent selection of a common toxicity grading criterion.
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Westhoff PG, de Graeff A, Monninkhof EM, de Pree I, van Vulpen M, Leer JWH, Marijnen CAM, van der Linden YM. Effectiveness and toxicity of conventional radiotherapy treatment for painful spinal metastases: a detailed course of side effects after opposing fields versus a single posterior field technique. ACTA ACUST UNITED AC 2017; 7:17-26. [PMID: 29576859 PMCID: PMC5856865 DOI: 10.1007/s13566-017-0328-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 12/25/2022]
Abstract
Background Conventional radiotherapy for painful spinal metastases can be delivered with a single posterior-anterior (PA) or two opposed anterior-posterior (APPA) fields. We studied the effectiveness and toxicity of both techniques and studied whether treatment technique was predictive for abdominal and skin toxicity. Patients and methods Within the Dutch Bone Metastasis Study, 343 patients received 8 Gray in a single fraction or 24 Gray in six fractions for painful spinal metastases. Treatment technique was not randomized. At baseline and weekly during follow-up, patients reported pain and other physical complaints. Any complaint increasing within 4 weeks after treatment was noted as a side effect. Pain response was calculated according to international standards, taking into account changes in pain score and medication. Repeated measurement analyses and multivariate logistic analyses were performed. Results Patients were mainly treated on the thoracic (34%) and lumbar (53%) spine and 73% received a PA field. Pain response was similar between both techniques (74%). In patients treated at the thoraco-lumbar and lumbar spine, with multiple fractions, significantly more abdominal complaints were noticed. In multivariate analysis, radiotherapy technique did not predict for side effects. Conclusion Conventional radiotherapy of painful spinal metastases provides limited toxicity. Radiotherapy technique is not an independent predictor of abdominal and skin toxicity of irradiation.
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Affiliation(s)
- Paulien G Westhoff
- 1Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.,2Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Alexander de Graeff
- 3Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- 4Julius center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Ilse de Pree
- 5Department of Radiation Oncology, Erasmus Medical Center, PO Box 5201, 3008 AE Rotterdam, the Netherlands
| | - Marco van Vulpen
- 1Department of Radiation Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Jan Willem H Leer
- 2Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Corrie A M Marijnen
- 6Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Yvette M van der Linden
- 6Department of Radiation Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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Huo M, Sahgal A, Pryor D, Redmond K, Lo S, Foote M. Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation. Surg Neurol Int 2017; 8:30. [PMID: 28303210 PMCID: PMC5339918 DOI: 10.4103/2152-7806.200581] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Uncertainty exists regarding the optimal dose and fractionation schedule, with single and multifraction regimens commonly utilized. METHODS A literature search of the PubMed and Medline databases was conducted to identify papers specific to spine SBRT and the effect of varying dose/fractionation regimens on outcomes. Bibliographies of relevant papers were searched for further references, and international spine SBRT experts were consulted. RESULTS Local control rates generally exceed 80% at 1 year, while high rates of pain control have been attained. There is insufficient evidence to suggest superiority of either single or multiple fraction regimens with respect to local control and pain control. Low rates of toxicity have been reported, assuming strict dose constraints are respected. Radiation myelopathy may be the most morbid toxicity, although the rates are low. The risk of vertebral compression fracture appears to be associated with higher doses per fraction such as those used in single-fraction regimens. The Spinal Instability Neoplastic Score should be considered when evaluating patients for spine SBRT, and prophylactic stabilisation may be warranted. Pain flare is a relatively common toxicity which may be mediated with prophylactic dexamethasone. Because of the treatment complexity and potentially serious toxicities, strict quality assurance should occur at the organizational, planning, dosimetric, and treatment delivery levels. CONCLUSION Both single and multifraction regimens are safe and efficacious in spine SBRT for spinal metastases. There may be advantages to hypofractionated treatment over single-fraction regimens with respect to toxicity. Ongoing investigation is underway to define optimal dose and fractionation schedules.
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Affiliation(s)
- Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Kristin Redmond
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, USA
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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Lo SS, Foote M, Siva S, Slotman BJ, Teh BS, Guckenberger M, Tan D, Mayr NA, Sahgal A. Technical know-how in stereotactic ablative radiotherapy (SABR). J Med Radiat Sci 2016; 63:5-8. [PMID: 27087969 PMCID: PMC4775826 DOI: 10.1002/jmrs.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 11/20/2022] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is an addition to the armamentarium against cancer. The technical requirements for SABR are very stringent, given its very narrow therapeutic window. However, when the principles are strictly followed, it is possible to deliver SABR to extracranial tumours safely and effectively.![]()
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Affiliation(s)
- Simon S Lo
- Department of Radiation Oncology University Hospitals Seidman Cancer Center Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital School of Medicine University of Queensland Queensland Australia
| | - Shankar Siva
- Division of Radiation Oncology Peter MacCallum Cancer Centre East Melbourne Victoria Australia
| | - Ben J Slotman
- Department of Radiation Oncology VU University Medical Center Amsterdam Netherlands
| | - Bin S Teh
- Department of Radiation Oncology Houston Methodist Hospital Weill Cornell Medical College Houston Texas USA
| | | | - Daniel Tan
- Asian American Radiation Oncology Singapore
| | - Nina A Mayr
- Department of Radiation Oncology University of Washington Seattle Washington USA
| | - Arjun Sahgal
- Department of Radiation Oncology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada
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